Gastroschisis: Mortality risks with each additional week of expectant management

Teresa N. Sparks, Brian Shaffer, Jessica Page, Aaron Caughey

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Background: Prior studies have evaluated the overall risk of stillbirth in pregnancies with fetal gastroschisis. However, the gestational age at which mortality is minimized, balancing the risk of stillbirth against neonatal mortality, remains unclear. Objective: We sought to evaluate the gestational age at which prenatal and postnatal mortality risk is minimized for fetuses with gastroschisis. Study Design: This was a retrospective cohort study of singleton pregnancies delivered between 24 0/7 and 39 6/7 weeks, using 2005 through 2006 US national linked birth and death certificate data. Among pregnancies with fetal gastroschisis, prospective risk of stillbirth and risk of infant death were determined for each gestational age week. Risk of infant death with delivery was further compared to composite fetal/infant mortality risk with expectant management for 1 additional week. Results: Among 2,119,049 pregnancies, 860 cases (0.04%) of gastroschisis were identified. The overall stillbirth rate among gastroschisis cases was 4.8%, and infant death occurred in 8.3%. Prospective risk of stillbirth became more consistently elevated beginning at 35 weeks, rising to 13.9 per 1000 pregnancies (95% confidence interval, 10.8-17.1) at 39 weeks. Risk of infant death concurrently nadired in the third trimester, ranging between 62.4-66.8 per 1000 live births between 32-39 weeks. Comparing mortality with expectant management vs delivery, relative risk was significantly greater with expectant management between 37-39 weeks, reaching 1.90 (95% confidence interval, 1.73-2.08) at 39 weeks with a number needed to deliver of 17.49 (95% confidence interval, 15.34-20.32) to avoid 1 excess death. Conclusion: Risk of prenatal and postnatal mortality for fetuses with gastroschisis may be minimized with delivery as early as 37 weeks.

Original languageEnglish (US)
JournalAmerican Journal of Obstetrics and Gynecology
DOIs
StateAccepted/In press - May 19 2016

Fingerprint

Gastroschisis
Mortality
Stillbirth
Pregnancy
Gestational Age
Infant Mortality
Confidence Intervals
Fetus
Birth Certificates
Fetal Mortality
Death Certificates
Third Pregnancy Trimester
Live Birth
Cohort Studies
Retrospective Studies

Keywords

  • Gastroschisis
  • Intrauterine fetal demise
  • Neonatal death
  • Stillbirth

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Gastroschisis : Mortality risks with each additional week of expectant management. / Sparks, Teresa N.; Shaffer, Brian; Page, Jessica; Caughey, Aaron.

In: American Journal of Obstetrics and Gynecology, 19.05.2016.

Research output: Contribution to journalArticle

@article{de273e71865e452b86cd1af70683c990,
title = "Gastroschisis: Mortality risks with each additional week of expectant management",
abstract = "Background: Prior studies have evaluated the overall risk of stillbirth in pregnancies with fetal gastroschisis. However, the gestational age at which mortality is minimized, balancing the risk of stillbirth against neonatal mortality, remains unclear. Objective: We sought to evaluate the gestational age at which prenatal and postnatal mortality risk is minimized for fetuses with gastroschisis. Study Design: This was a retrospective cohort study of singleton pregnancies delivered between 24 0/7 and 39 6/7 weeks, using 2005 through 2006 US national linked birth and death certificate data. Among pregnancies with fetal gastroschisis, prospective risk of stillbirth and risk of infant death were determined for each gestational age week. Risk of infant death with delivery was further compared to composite fetal/infant mortality risk with expectant management for 1 additional week. Results: Among 2,119,049 pregnancies, 860 cases (0.04{\%}) of gastroschisis were identified. The overall stillbirth rate among gastroschisis cases was 4.8{\%}, and infant death occurred in 8.3{\%}. Prospective risk of stillbirth became more consistently elevated beginning at 35 weeks, rising to 13.9 per 1000 pregnancies (95{\%} confidence interval, 10.8-17.1) at 39 weeks. Risk of infant death concurrently nadired in the third trimester, ranging between 62.4-66.8 per 1000 live births between 32-39 weeks. Comparing mortality with expectant management vs delivery, relative risk was significantly greater with expectant management between 37-39 weeks, reaching 1.90 (95{\%} confidence interval, 1.73-2.08) at 39 weeks with a number needed to deliver of 17.49 (95{\%} confidence interval, 15.34-20.32) to avoid 1 excess death. Conclusion: Risk of prenatal and postnatal mortality for fetuses with gastroschisis may be minimized with delivery as early as 37 weeks.",
keywords = "Gastroschisis, Intrauterine fetal demise, Neonatal death, Stillbirth",
author = "Sparks, {Teresa N.} and Brian Shaffer and Jessica Page and Aaron Caughey",
year = "2016",
month = "5",
day = "19",
doi = "10.1016/j.ajog.2016.08.036",
language = "English (US)",
journal = "American Journal of Obstetrics and Gynecology",
issn = "0002-9378",
publisher = "Mosby Inc.",

}

TY - JOUR

T1 - Gastroschisis

T2 - Mortality risks with each additional week of expectant management

AU - Sparks, Teresa N.

AU - Shaffer, Brian

AU - Page, Jessica

AU - Caughey, Aaron

PY - 2016/5/19

Y1 - 2016/5/19

N2 - Background: Prior studies have evaluated the overall risk of stillbirth in pregnancies with fetal gastroschisis. However, the gestational age at which mortality is minimized, balancing the risk of stillbirth against neonatal mortality, remains unclear. Objective: We sought to evaluate the gestational age at which prenatal and postnatal mortality risk is minimized for fetuses with gastroschisis. Study Design: This was a retrospective cohort study of singleton pregnancies delivered between 24 0/7 and 39 6/7 weeks, using 2005 through 2006 US national linked birth and death certificate data. Among pregnancies with fetal gastroschisis, prospective risk of stillbirth and risk of infant death were determined for each gestational age week. Risk of infant death with delivery was further compared to composite fetal/infant mortality risk with expectant management for 1 additional week. Results: Among 2,119,049 pregnancies, 860 cases (0.04%) of gastroschisis were identified. The overall stillbirth rate among gastroschisis cases was 4.8%, and infant death occurred in 8.3%. Prospective risk of stillbirth became more consistently elevated beginning at 35 weeks, rising to 13.9 per 1000 pregnancies (95% confidence interval, 10.8-17.1) at 39 weeks. Risk of infant death concurrently nadired in the third trimester, ranging between 62.4-66.8 per 1000 live births between 32-39 weeks. Comparing mortality with expectant management vs delivery, relative risk was significantly greater with expectant management between 37-39 weeks, reaching 1.90 (95% confidence interval, 1.73-2.08) at 39 weeks with a number needed to deliver of 17.49 (95% confidence interval, 15.34-20.32) to avoid 1 excess death. Conclusion: Risk of prenatal and postnatal mortality for fetuses with gastroschisis may be minimized with delivery as early as 37 weeks.

AB - Background: Prior studies have evaluated the overall risk of stillbirth in pregnancies with fetal gastroschisis. However, the gestational age at which mortality is minimized, balancing the risk of stillbirth against neonatal mortality, remains unclear. Objective: We sought to evaluate the gestational age at which prenatal and postnatal mortality risk is minimized for fetuses with gastroschisis. Study Design: This was a retrospective cohort study of singleton pregnancies delivered between 24 0/7 and 39 6/7 weeks, using 2005 through 2006 US national linked birth and death certificate data. Among pregnancies with fetal gastroschisis, prospective risk of stillbirth and risk of infant death were determined for each gestational age week. Risk of infant death with delivery was further compared to composite fetal/infant mortality risk with expectant management for 1 additional week. Results: Among 2,119,049 pregnancies, 860 cases (0.04%) of gastroschisis were identified. The overall stillbirth rate among gastroschisis cases was 4.8%, and infant death occurred in 8.3%. Prospective risk of stillbirth became more consistently elevated beginning at 35 weeks, rising to 13.9 per 1000 pregnancies (95% confidence interval, 10.8-17.1) at 39 weeks. Risk of infant death concurrently nadired in the third trimester, ranging between 62.4-66.8 per 1000 live births between 32-39 weeks. Comparing mortality with expectant management vs delivery, relative risk was significantly greater with expectant management between 37-39 weeks, reaching 1.90 (95% confidence interval, 1.73-2.08) at 39 weeks with a number needed to deliver of 17.49 (95% confidence interval, 15.34-20.32) to avoid 1 excess death. Conclusion: Risk of prenatal and postnatal mortality for fetuses with gastroschisis may be minimized with delivery as early as 37 weeks.

KW - Gastroschisis

KW - Intrauterine fetal demise

KW - Neonatal death

KW - Stillbirth

UR - http://www.scopus.com/inward/record.url?scp=85001819576&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85001819576&partnerID=8YFLogxK

U2 - 10.1016/j.ajog.2016.08.036

DO - 10.1016/j.ajog.2016.08.036

M3 - Article

C2 - 27596619

AN - SCOPUS:85001819576

JO - American Journal of Obstetrics and Gynecology

JF - American Journal of Obstetrics and Gynecology

SN - 0002-9378

ER -